Delta South Elementary School

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Student Name	Lastname	,	Firstname	-	ID#
Student Name

School Lunch Fees

Reduced Lunch Monthly*:

$8.00

Select:

Item Subtotal:

$0.00

Reduced Lunch Yearly*:

$72.00

Select:

Item Subtotal:

$0.00

Regular Lunch Monthly:

$45.00

Select:

Item Subtotal:

$0.00

Regular Lunch Yearly:

$405.00

Select:

Item Subtotal:

$0.00

*All applications for free or reduced lunch must be submitted online at https://www.myschoolapps.com for processing.

Total:

$0.00

Parent/Guardian Information

First Name:	Last Name:
Address:
Address:
City:	State/Province:	ZIP/Postal Code:
Phone:
Email:

Payment Information:

Processing Fee Rates:
Cards:	3% plus $0.50 ($1.50 min) (1.5% surcharge for foreign cards)
eCheck:	$0.49

Method of Payment:	Credit/Debit Card eCheck
Update Name from Above

Name on Account:
Routing Number:
Account Number:
Institution:

Name on Card:
Account Number:
Expiration Date:
Billing Street Address:
Billing ZIP/Postal Code:

Change Payment Method

Your statement will describe your payment as ‘CBT*MILLARD SCHOOL DI’ and the service fee transaction as ‘CBT*SVC FEE MILLARD S’

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